Archive for health care reform


Hospital Government Payment Losses Could Reach $218 Billion by 2028

A recent study concluded that hospitals can expect to lose about $218 billion in federal Medicare and Medicaid payments between 2010, when the latest round of major cuts began, and 2028.

Among those cuts cited in the study, which was commissioned by the American Hospital Association and the Federation of American Hospitals, are:

  • $79 billion for DRG documentation and coding adjustments
  • $73 billion for Medicare sequestration
  • $26 billion for Medicaid disproportionate share payments (Medicaid DSH)
  • $11 billion in cuts associated with the American Taxpayer Relief Act of 2012

Other cuts came, or will be coming, through regulatory changes, the introduction of value-based payment programs, and other means.

Learn more about these cuts and their potential implications in this Healthcare Dive story.


Programs, Not Penalties, Drive Readmission Reductions

Participating in federal value-based payment programs does more to reduce hospital readmissions than penalties levied on hospitals with too many readmissions.

Or so reports a new study published by JAMA Internal Medicine.

According to the study, hospitals that participated in one or more of three Medicare value-based payment programs ­– its meaningful use of electronic health records program, the bundled payment for care initiative, or an accountable care organization (ACO) program – enjoyed bigger decreases in their avoidable Medicare readmissions than hospitals that participated in no such programs but were only subject to financial penalties levied under the Medicare hospital readmissions reduction program.

The study encompassed more than 2800 hospitals.

Learn more about these findings in this Fierce Healthcare article or go here, to the JAMA Internal Medicine web site, for the report “Association Between Hospitals’ Engagement in Value-Based Reforms and Remission Reduction in the Hospital Readmission Reduction Program.”…

Social Determinants and Health Care

Amid growing recognition that social factors play at least much a role in the health of communities as medical care, growing attention is being paid to how best to address those social determinants in a health care system.

With increasing use of alternative delivery models such as accountable care organizations, some approaches place health care at the heart of a hub-and-spoke model to address population health, supported by functions such as affordable housing, home health care, job training, and more. Another approach places community organizations at the hub of care models, with the health care system as a spoke feeding into that hub.

A recent article on the Health Affairs Blog explores the hub-and-spoke approach to addressing the social determinants that play such a major role in population health. Go here to read the blog article “Defining The Health Care System’s Role In Addressing Social Determinants And Population Health.”…

New Series Examines Serving High-Need, High-Cost Patients

The Commonwealth Fund is launching a new series of case studies describing “innovative programs designed to address the needs of the nation’s high-need, high-cost patients, a group that accounts for a disproportionate share of health care spending.”

Among the types of programs it will profile are:

  • home-based primary care
  • enhanced primary care
  • programs of all-inclusive care (PACE)
  • accountable care for Medicaid populations
  • guided care

For a closer look at the new series and the programs it will profile go here, to the web site of the Commonwealth Fund.…

CMS Reports on Innovation Programs

The Centers for Medicare & Medicaid Services has published progress reports for the second year of Affordable Care Act-inspired innovation programs.

Under the 2010 health care reform law, the agency was directed to pursue innovation in the delivery and payment of health care services. Since that time, CMS has introduced a number of demonstration programs designed to test new ways of delivering and paying for government-insured medical services.

Reporting on the second year of innovation programs, Dr. Patrick Conway, CMS principal deputy administrator and chief medical officer presented highlights of these innovations in the CMS blog.

In addition, CMS has published evaluation reports on key innovation areas, including:

  • behavioral health/substance abuse
  • complex/high-risk patient targeting
  • community resource planning, prevention, and monitoring
  • disease-specific programs
  • diabetes prevention programs
  • hospital setting health care innovation
  • primary care redesign programs
  • shared medical decision-making and medication management

Find Dr. Conway’s overview of CMS’s innovation efforts here, in the CMS blog, and find links to the evaluation reports here (under “year two reports”).…